Superior mesenteric artery first approach can improve the clinical outcomes of pancreaticoduodenectomy: A meta-analysis

INTERNATIONAL JOURNAL OF SURGERY

卷:73

Review

Jiang, Xiangyan¹  Yu, Zeyuan¹  Ma, Zhijian²  Deng, Haixiao¹  Ren, Wen²  Shi, Wengui²  Jiao, Zuoyi^1,2 

[1] Lanzhou Univ, Dept Gen Surg, Hosp 2, Lanzhou 730000, Peoples R China

[2] Lanzhou Univ, Cui Ying Biomed Res Ctr, Hosp 2, Lanzhou, Peoples R China

关键词: Superior mesenteric artery;    Pancreaticoduodenectomy;    Pancreatic cancer;    RO resection;   

DOI  :  10.1016/j.ijsu.2019.11.007

来源: Elsevier

【 摘 要 】

Background and aim: Superior mesenteric artery (SMA) first approach was a new improvement for pancreaticoduodenectomy (PD), but there is no evidence whether this approach is advantageous to PD. This meta-analysis aimed to determine the effects of the superior mesenteric artery (SMA) first approach on outcomes of pancreaticoduodenectomy (PD). Methods: Literature searches were conducted on PubMed, The Cochrane Library, EMBASE, Web of Science, Clinical Trials Registry and China Biology Medicine disc. We completed a meta-analysis of the SMA first approach in PD, assessing overall survival, R0 resection, blood loss, postoperative complications, operation time and postoperative stay. The odds ratios and weighted mean differences with 95% confidence intervals (CIs) were pooled. Results: Eighteen studies comprising 1483 participants were included. Patients who received SMA-PD had significantly lower overall complication rate (OR 0.62, 95% CI 0.47 to 0.81, P = 0.001) and less blood loss (WMD -264.84, 95% CI -336.1 to - 193.58, P < 0.001). The obviously increased R0 resection rate (OR 2.92, 95% CI 1.72 to 4.96, P < 0.001) and 3-year OS (OR 2.15, 95% CI 1.34 to 3.43, P = 0.001) were found in the SMA-PD group. Conclusion: The SMA-PD group had better clinical outcomes, particularly in long-term survival of pancreatic cancer patients; furthermore, the patients acquired superior clinical efficacy via the posterior approach in SMAPD.

【 授权许可】

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